Are We Moving Towards Assisted Suicide

“Those who have exhausted the end seek the right to die with dignity, this is a choice to die, which allows the body to speak its end rather than have that end dictated by the voice of an expert, legal or medical” (Hannifin. 2009, p.84) The person who seeks to die is, to paraphrase Foucault, ‘the Passenger par excellence: that is, the prisoner of the passage’ (Foucault. 1967, p.11)

The European Convention on Human Rights sets out a number of fundamental rights and freedoms, right to life, prohibition of torture, prohibition of slavery and forced labour, right to liberty and security, right to a fair trial, no punishment without law, right to respect and family life, freedoms of thought, conscience and religion, freedom of expression, freedom of assembly and association, right to marry, right to effective remedy, and prohibition of discrimination

The Council of Europe produced the European Convention on Human Rights and Fundamental Freedoms in 1950. This body was formed in the aftermath of the Second World War to achieve unity among its members in such matters as the protection of fundamental rights. The Convention was drafted after the atrocities of the Second World War. The Convention was signed by the High Contracting Parties in 1950, and came into force in1953. It was ratified by the United Kingdom in 1957.

Article 2 of the Convention for the Protection of Human Rights and Fundamental freedoms protects the right to life.[1] The right to life is the first substantive right proclaimed in the convention because it is the most basic human right of all; if you could arbitrarily be deprived of your life; all other rights would become illusory.

The Convention does not clarify what life is or when it starts. In the absence of a European or worldwide legal or scientific consensus on the matter, the European Court of Human Rights is unwilling to set precise standards; the issue of when the life begins comes within the margin of appreciation which the Court generally considers that States should enjoy… The reasons for this conclusion are, firstly, that the issue of such protection has not been resolved within the major contracting states, and that there is no European consensus on the scientific and legal definition of the beginning of life….[2]

In the last two decades, many countries have grappled with the dilemmas associated with advanced technology, greater life expectancy, and the difficulties of unbearable suffering (Bamgbose, 2004. p111). The Universal Declaration of Human Rights (1948), The United Nations Charter (1945), European Convention for the Protection of Human Rights and Fundamental Freedom (1950), American Convention of Human Rights (1969) and the African Charter on Human and People Rights (1969) are some of the instruments that explicitly and implicitly prohibit the unlawful taking of life.

When it comes to the medical profession, The Hippocratic oath of 400 BC declares “I will give no deadly medicine to anyone if asked, nor suggest such council”, the modern version of the oath states “I will neither prescribe nor administer a lethal dose of medicine to any patient even if asked nor counsel any such thing, to have the utmost respect for every human life from fertilization to natural death and reject abortion that deliberately takes a unique human life”.[3] The Statement of Marbella (1992) states, “Physician-assisted suicide, like euthanasia, is unethical and must be condemned by the medical profession” (Myers, 2000). Article 2 of the Convention for the Protection of Human Rights and Fundamental Freedoms protects the right to life[4]. Apart from the death penalty, the Convention states only limited circumstances in which a person can be deprived of this right; none of these refer to suicide or euthanasia.

The whole approach to protecting this right has changed considerably with scientific and medical advances. Whereas traditionally the concern was to protect life from all threats, today there are the additional very prominent issues of human – scientific and medical – intervention in life-giving process in such forms as abortion, procreation, embryo research cloning and euthanasia” (Mathieu, 2006). In our societies, the voices that insist that everyone must have the right to die with dignity are growing steadily louder, but euthanasia still raises numerous questions that remain controversial.

As per Srinivas “The legality of the ban on assisted suicide and euthanasia and the scope of prosecutorial discretion have recently come under scrutiny, especially as British citizens have begun to take advantage of the more liberal suicide laws in neighboring European countries like Switzerland” (Srinivas 2009 pp. 111 –112.).

In May of 2011 in Switzerland, voters rejected the proposal to ban assisted suicide to non-residents by 78%. Assisted suicide is legal in Switzerland, and has been since 1941, provided the helper isn’t a medical doctor and doesn’t personally benefit from a patient’s death. Article 115 of the Swiss penal code considers assisting suicide a crime if and only if the motive is selfish. It condones assisting suicide for altruistic reasons. Article 115 does not require the involvement of a physician nor the patient to be terminally ill. The Swiss law does not consider suicide a crime or assisting suicide as complicity in a crime.
Euthanasia was exempted from criminal law in the Netherlands on April 1st 2002 under certain circumstances. The Termination of Life on Request and Assisted Suicide Review procedures Act formalized the situation that had existed in The Netherlands since 1973.

According to Manzione, a recent movement to legalize assisted suicide and euthanasia has swept across some of the globe’s wealthier industrialized nations (Manzione, 2002).
While a handful of jurisdictions in Europe and the United States have legalized assisted suicide with varying degrees of restriction, laws that allow the practice remain the exception rather than the rule in most of the developed world.

On April 1st 2002, legislation regarding the practice of euthanasia and assisted suicide became effective in the Netherlands.[5] This new law made the Netherlands the first country to legalize euthanasia. As per Manzione, (2002) The Northern Territory of Australia passed an act on May 25th, 1995 authorizing euthanasia, which came into effect on July 1st, 1996. The Act was in force for less than a year. On March 25th, 1997 the Australian National Assembly invalidated it.

Stedman’s Medical Dictionary (1990) defines euthanasia as: “A quite, painless death, the intentional putting to death of a person with an incurable or painful disease” (p.544). The literature frequently refers to euthanasia as meaning something different depending on whether the argument is for or against euthanasia (Johnstone, 1996). The terms suicide and euthanasia are concepts with blurred boundaries, because it is often considered unclear whether a certain act counts as suicide or whether it is an instance of euthanasia (McMahan, 2002).

The Irish Council of Bioethics detail that the word euthanasia stems from the Greek words “euthanatos” meaning “good death”, and refers to the action of a third party usually a doctor deliberately ending the life on an individual. The individual must give consent for the procedure, which is known as voluntary euthanasia.

Non-voluntary euthanasia occurs when the individual is unable to ask for the procedure e.g. if the patient is unconscious or otherwise unable to communicate and another person makes the decision on the patient’s behalf. In such cases the final decision may be based on an advanced directive or living will. Assisted suicide refers to the practice of an individual taking his own life on the bases of information, guidance and / or medication provided by a third party. As an example a doctor might prescribe a lethal dose of medication for an individual, who then administers the medication him or herself

It is currently illegal in the United Kingdom to perform any act intended to end another person’s life, to be present at or to aid someone’s suicide.[6] Any person who performs euthanasia may be prosecuted for murder.[7]

Until 1961, suicide was a crime in England and Wales, reflecting a common Christian morality that condemned the act of self-murder. With the suicide Act of 1961, Parliament formally decriminalized the act of suicide. It also asserted that while providing assistance in another person’s suicide attempt should remain a criminal offence, no prosecution could be brought for assisting a suicide except by, or with consent of the Director of Public Prosecutions (DPP) (O’Neill, 2010).

The United Kingdom’s Suicide Act 1961, provides that A person who aids, abets, counsels or procures the suicide of Another, or an attempt by another to commit suicide, shall be Liable on conviction on indictment to imprisonment.

This act broadly covers all aspects of assisted suicide, and like many other governments, the UK government dropped criminal sanctions for the person attempting suicide in the 1961 Act. The amendment to the Act did not confer a right for anyone to do so; the policy of the law remained firmly adverse to suicide. Assisted suicide is a particularly unique offence being the only act in the English jurisdiction that is legal to carry out but illegal to assist.

Parliament in the United Kingdom repeatedly defeated attempts to change the Suicide Act of 1961. In 2002 and 2003, Lord Joffe tried unsuccessfully to legalize assisted suicide by proposing the Patient (Assisted Dying) bill, also known as the Assisted Dying for the Terminally Ill Bill.

Parliament again rejected pro-suicide proposals in 2005 and in 2006.[8] In May 2006 Lord Joffe argued in an address to the House of Lords that every year in the United Kingdom some doctors do break the law and perform some form of assisted dying. A number of surveys were understood to demonstrate this, one survey according to Tate and Ward, (1994) on General Parishioners and Consultants found that 12 per cent of respondents claimed to have complied with a request to prematurely end a patient’s life. Lord Joffe argued that these results are a risk to patients and a danger to doctors and careers[9]. In the 2005 bill Lord Joffe proposed that palliative care should always be the first option for someone who is terminally ill and that assisted death should be the last resort (London: The Stationary Office. 2005 p.87) On the issue of palliative care, the Parliamentary Assembly of the Council of Europe recommends that the member states should: (pp2-4) Ensure that, unless the patient chooses otherwise, a terminally ill or dying person will receive adequate pain relief and palliative care, even if this treatment as a side effect may contribute to the shortening of the individuals life.[10]

The law on assisted suicide in the United Kingdom came under increasing pressure following some very high profile cases form 2001 onwards.

In October 2001, Mrs. Diane Pretty was a forty-three English citizen who was in the advanced stages of motor neuron disease (MND) that had caused her to become a quadriplegic. She was very aware that in time she would loose muscle control and eventually die of respiratory failure. Mrs. Pretty’s mental abilities were un-affected by the MND.

Mrs. Pretty wanted to end her suffering and pain but due to her MND she was physically incapable of committing suicide, which is not illegal under English law.
Mrs. Pretty sought a guarantee from the Director of public Prosecutions (DPP) that her husband, if he helped her to commit suicide, would be immune from prosecution. The DPP refused to give an undertaking under section 2 (1) of the 1961 suicide act. Mrs. Pretty applied for judicial review of the DPP’s refusal. On the 17th October 2001, the Divisional Court refused the application holding that the DPP did not have the power to give the undertaking not to prosecute and that section 2 (1) of the Suicide Act 1961 was not incompatible with the Convention. Ms Pretty had alleged infringement of Article 2[11] on the right to life, article 3[12] on the prohibitions of torture and degrading treatment, article 8[13] on the right to respect for private and family life, article 9[14] freedom of thought, conscience and religion and article 14 on non-discrimination.[15]

Ms Pretty took her case to the House of Lords who communicated their decision on 29th November 2001. They again refused her appeal under section 2 (1) of the 1961 Suicide Act.[16] In rejecting Mrs. Pretty’s claim, the House of Lords relied upon traditional views express in the sanctity of life doctrine and established definitions of key terms in the Article.
The House held that Article 2 guarantees a right to life and embodies the sanctity of life doctrine with the result that no one can be deprived of life by methods involving deliberate human interference.

Article 3 was held not to impose a positive obligation on the United Kingdom to ensure Assisted Suicide to a person who was terminally ill or to guarantee that the person providing Assisted Suicide would not be prosecuted. In addition the Lords felt that this case did not involve inhuman or degrading treatment. Article 8 the Lords stated, related to how a person lives his life and not how they depart from it, Article 9 entitled Mrs. Pretty to believe in assisted suicide but the house could not authorize assisted suicide that was an illegal act. The Lords also contended that Article 14 did not come into play, as Mrs. Pretty was not discriminated under any of the articles.

Five months later, the European Court of Human Rights ruled unanimously that the refusal of the government to allow Mrs. Pretty’s husband to help her to die did not violate the Convention.[17] Apart from receiving submissions from the applicant and the respondent government the court also allowed third-party interventions by the Voluntary Euthanasia Society, and by the Roman Catholic Bishops’ Conference of England and Wales.

The Court was not persuaded that Article 2 “the right to life” could be interpreted in the negative. The court stated that “Article 2 cannot, without a distortion of language, be interpreted as conferring the diametrically opposite right, namely the right to die; nor can it create a right to self-determination in the sense of conferring on an individual the entitlement to choose death rather than life”. The Court accordingly found that no right to die, whether at the hands of a third person or with the assistance of a public authority, could be derived from Article 2 of the Convention.[18] In terms of Article 3, the court felt that it must be construed in harmony with Article 2, and the state did not have to facilitate the death of a person, that the state did not have a positive duty to prevent degrading treatment by allowing a person to take their own life. It was beyond dispute the UK Government had not inflicted any ill treatment on Mrs. Pretty. Under Article 9 the court claimed – not all opinions or convictions constitute beliefs in the sense of this provision and Mrs. Pretty’s claim did not involve a form of manifestation of religion or belief.

According to Wada (2005. p276) Although the ECHR did not expressly discuss the role of the margin of appreciation in its decision-making process, its application to the issue raised in Pretty v United Kingdom is the quintessential illustration of its proper usage. The Pretty case was the first time the ECHR confronted the issue of whether Article 2 of the Convention guaranteed the right to die. The court did however invoke the margin of appreciation in Article 2 of the Pretty case[19]; the court stated, “The margin will vary in accordance with the nature of and the importance of the interests at stake”.

The court disagreed with Pretty that the margin was too narrow, it stated that Article 2 is adamant about lawfulness, the right to life is supreme and must be protected, furthermore it stated that the requirement of “absolute necessity” in Article 2 means that any force used for any purposes mentioned in Article2 must be strictly proportionate to the achievements of any of the aims set out in paragraph 2.[20]

The Margin of appreciation is a concept developed by the ECtHR when considering whether a member state of the European Convention of Human Rights has breached the convention. The margin of appreciation doctrine allows the court to take into account the fact that the convention will be interpreted differently in different member states (range of discretion). Judges are obliged to take into account the cultural, historic and philosophical differences between Strasburg and the nation in question.[21]

Any international or regional human rights agreement can pose a treat to national sovereignty and to the political, cultural, and social differences that pertain in each country. The notion of flexible enforcement in each member state appears to contradict the universal nature of rights, but the notion of the margin of appreciation is essential and has to recognize the autonomy of each state and the differing cultures among member states. The EctHR developed the concept to take into account the broadly drawn principles to the Convention and how they are interpreted in different societies. The margin of appreciation should not be confused with the term subsidiarity, where the smallest, lowest or least centralized authority handles matters.

In controversial topics such as bioethics or assisted suicide, the court will not make definitive stances, as this would mean ignoring the social and cultural values of the contracting nations. According to Cameron and Eriksson (1995) a lack of consensus among Member States suggests to the EctHR that the matter is best left to individual states.

In a second well-published case in the UK the appellant Debbie Purdy who suffers form multiple sclerosis for which there is known no cure wished her husband to be able to take her abroad to a jurisdiction such as Switzerland or Belgium that allowed assisted suicide. Such action would contravene section 2(1) of the 1961 suicide act in the UK (aiding and abetting the suicide of another). The penalty if convicted is imprisonment for a term of up to 14 years. Section 2(4) of the act provides that proceedings can only be brought with the consent of the DPP. According to Beckford, Its reported that more than 100 Britons have traveled to Dignitas, a suicide clinic in Switzerland, to end their lives and over 700 Britons are currently thought to be registered as members, there is some indications that the number of Britons making such a voyage is on the increase with reports of more than 30 individuals making the trip alone in 2009 (Beckford, 2010).[22]

The criminal prosecuting service had said it would not create a specific policy for assisted suicide but would consider each case on an individual basis and decide if prosecution was necessary. Ms Purdy sought a judicial review of the Director of Public Prosecutions (DPP) decision not to reveal details of how cases of assisted suicide are prosecuted in England and Wales. Ms. Purdy’s solicitor stated “ we are arguing that the right to life and the right to a private and family life under the European Convention of Human Rights should be interpreted broadly (margin of interoperation) and should include decisions about quality of life, including decisions about death if the quality of life is no longer good enough”
“On a practical level it is argued that the DPP should prepare a prosecution policy which tells the public what factors he will take into account when prosecuting in this area. It is only right that the public should know if they are likely to be charged with a criminal offence” (House of Commons Library 2010 P.8)

It was argued as per Mitchels, that the DPP had acted unlawfully either in failing to promulgate a policy or by failing to disclose the criteria which he applies in cases of this kind, whether he calls it a policy or not. Ms. Pretty believed that the prohibition in section 2 (1) of the 1961 Suicide Act constituted an interference with her right to respect for her private life in Article 8 (1) of the Convention for the Protection of Human rights and Fundamental Freedoms that was not in accordance with the law as required by Article 8 (2) in the absence of an offence-specific policy by the Director setting out the factors that would be taken into account under section 2 (4)
The court in their considerations departed from the Pretty case, stating that Article 8(1) was engaged, and the principle of legality in 8(2) required the court to consider whether the law was sufficiently accessible and sufficiently precise to enable a person affected by it to understand the scope and foresee the consequences of their conduct so as to regulate their conduct. (Mitchels, 2010 p2).

In July of 2009 Debbie Purdy obtained a House of Lords Ruling ordering the DPP (Keir Starmer QC) to formulate an offence-specific policy setting out the factors he will consider when deciding whether to prosecute assisted suicide offences.[23]

On the 23 of September 2009, the DPP published an interim policy and opened a 12-week public consultation on its contents. The final policy was published on the 25 February 2010. The policy sets out a variety of public interest factors that the Crown Prosecution Service (CPS) will consider when deciding whether to bring a prosecution for assisted suicide, focusing in particular on the motivations of the suspect.

This paper has discussed in some detail two very similar cases with some major differences in outcomes. The first major difference is that Diane Pretty died age 43 in a hospice shortly after the hearing in the European court. In a statement from her husband Brian said, “ Diane had to go through the one thing she had foreseen and was afraid of – and there was nothing I could do to help” (Speaking on BBC News 12 May 2002).[24]
The detail of both cases shows the progression of the debate on assisted suicide from a starting point of zero tolerance to a point at which the DPP has set out the legal reasons where a prosecution will follow on those who assist in a suicide.

Diane Pretty had found the quality of her life unbearable; she would have been the only person to make judgment on the quality of life she was living. As per Caplen, “quality means fitness for purpose” (Caplen, 1988 p1). Mrs. Pretty had asked for immunity for her husband, based on article 2. “The right to life” or in this case the inverse “the right to death” as she had no quality of life. Under the European Convention the right to life is paramount and as discussed earlier “The right to life is the first substantive right proclaimed in the convention because it is the most basic human right of all; if you could arbitrarily be deprived of your life; all other rights would become illusory”. Mrs. Prettys “appeal” to the DPP not to prosecute her husband had little hope of success, based on the scaticity of life. The DPP stated, “He could not grant immunities that condone, require, or purport to authorize or permit the future commission of any criminal offence, no matter what the circumstances”.

The EctHR in my opinion will not widen the margin of appreciation in cases where article 2 in being challenged. The diversity in cultures, religion and moral standings is so vast as to make it impossible to find agreement among the member states. Having said that, after The Assisted Dying Bill was defeated in May 2006, the Select Committee recommended that any future should make a distinction between Assisted Suicide and Assisted Voluntary Suicide. The Committee recommended that doctors’ powers should be better articulated, define ‘terminal illness’ and ‘competence, to reflect modern practice; consider changing ‘unbearable suffering’ to ‘unbelievable’ or intractable’ suffering; and abandon the requirement that a medical practitioner who objects to Assisted Voluntary Suicide or Assisted Suicide have to refer the patient to another doctor[25]. This has in my opinion advanced the possibility of another Bill for the Lords to review in the near future. The Lords have basically set out a template to follow for the development of the next Bill that seems they may accept. In 2009 there were two more attempts to legalise assisted suicide with a proposal to amend the coroners and Justice Bill, this goes to prove that the subject matter is still up fro debate. Lord Falconer proposed a bill to decriminalise the offence of assisting a person to travel to another jurisdiction to commit suicide where that person was terminally ill. The bill was again defeated by 194 votes to 141 votes.[26] Lord Alderdice proposed an amendment that would allow assisted suicide to a person who was suffering a ‘confirmed, incurable and disabling illness’ and had gotten certification from the Coroner who was satisfied that the person had a free and settled wish to end their life.[27] Had the Pretty’s waited until such a time, as Diane was ready to die with the assistance of her husband what would have been the outcome? Would The DPP have brought changes against him? I don’t believe so. In an NOP poll in October 2002 people were asked “Do you think that a person who is suffering unbearably from terminal illness should be allowed by law to receive medical help to die, if this is what they want, or should the law not allow them to receive this medical help to die”
81% said “yes’ the law should allow them to receive medical help to die, 12% said no, with 6% don’t know (House of Lords, Select Committee on the Assisted Dying for the Terminally Ill Bill. 4th April 2005. p.512) The report went on to say at page 513 “ The opinion polls give us a picture of what the public thinks but we should also look at informed public debate, and these suggest similar conclusions”.[28] It’s quite clear that public opinion was with the Pretty family at this time and that a charge was highly unlikely from the DPP but the risk of a charge was still there if Mr. Pretty helped Mrs. Pretty to die, this was the risk Mrs. Pretty was not willing to take.

The second case of Debbie Purdy may not have opened the door on assisted suicide but has maybe put a crack in the door to shine light on the situations in which the DPP will prefer charges. Spencer suggests, “The main significance of this case is that it makes a step along the road towards making assisted suicide legal” (Spencer, 2009. p495). Ms Purdy knows what her future is and it’s not a pretty one. The DPP has given her and many others like her a glimmer of hope. She is now aware under which circumstance she can be assisted in death by her husband with a much reduced risk that he will be prosecuted. The DPP has basically set out the criteria to be followed to prevent the prosecution, is it a case that the DPP has brought some discretion into the prosecutorial decision making process? It’s clear that the guidelines amount to a change in the law because they alter the way the law now operates. The policy provides a list of public interest factors that will be taken into account, alongside the Code for Crown Prosecutors when a decision is made on whether to prosecute or not. The law on assisted suicide has not changed, but it is now clearer from the DPP’s policy when prosecutions would and would not be pursued. As per Baroness Campbell “they are not just guidelines; they are the beginning of the process. Once you open the door a crack, you’re beginning to sanction or say to a culture ‘yes’ in some circumstances it is right to mercy kill disabled or terminally ill people. I would say to you; that’s very dangerous”.[29] In the case of Ms Purdy, she can now stay in the United Kingdom for much longer and not have to travel alone to a country such as Switzerland where assisted suicide is legal. A case was tested under the new law in March 2010. The son of Lady Downs and Sir Edward accompanied them to Dignitas in July of 2009 the case was considered but no prosecution followed.[30]

In another case prior to the publication of the DPPs policy document, a retired policeman Mr. Brian Blackburn helped his wife to die by cutting her wrists. Mrs. Blackburn was in agoinising pain with advanced stomach cancer. Mr. Blackburn tried to kill himself but failed. He was arrested and charged with murder. He spent three months in prison awaiting trial. At his trial, Judge Hawkins told Mr. Blackburn that he had acted as a ‘loving husband’ when his wife had begged him to kill her, the judge went on to say ‘ that was the last loving thing you could do for her’. Mr. Blackburn received a nine month suspended sentence. It seems even the judiciary have a sympathetic view around the subject of assisted suicide.

The question to be asked at this juncture is “were the responses of just 5000 people enough from a population of 54 million in England and Wales to draw a reasonable conclusion on public opinion on assisted suicide. Why the question of assisted suicide is is not put the population as a whole? If the NOP public opinions of 2008 were any reference to go by it seems the introduction of assisted suicide would be carried. In another survey of 1002 UK doctors in all specialties in 2004, it was found that 56% thought physician assisted suicide should be permitted when a person has a terminal illness with uncontrollable physical suffering. (Medixuk.com 2004). It’s critical to keep in mind that Voluntary Euthanasia Society sponsored this particular survey and so I would question its credibility and validity. If the survey is credible we may be seeing a sea change in the medical profession towards assisted suicide.

The debate on euthanasia, assisted suicide and physician-assisted suicide from a multidimensional perspective will continue for sometime to come. The different arguments from various stakeholders will linger. In an Article by Elizabeth Cleary, it showed just how topical the subject of euthanasia has become. A search conducted of the Lexis-Nexis data base of all UK newspapers in 1990 showed around 100 articles that referred to assisted dying, euthanasia or assisted suicide. In 2005 in contrast over 2,600 articles appeared (Clery et. al. 2007). Moral norms change over time, it’s not so long since homosexuality, same sex marriage, abortion and many other debated issues were frowned upon. As circumstances change people will find ways to justify their moral changes. Advances in modern technology and the prolonging of life may be that catalyst for change.

The economic circumstance in which we find ourselves today may play a very important role in the debate on assisted suicide in the future. Because of medical advances in technology and drugs people will live longer. Older people by nature require more medical attention at higher costs to society. The harsh economic facts of life are that we may not be able to financially support the costs of an ageing population in the future.
It also seems that there may be a change in the attitudes of medical profession that runs in contrast to the Hippocratic Oath as detailed earlier. The law currently allows patients to refuse life sustaining treatment, or to request it to be removed even if the doctors do not believe it to be a rational decision. As many as 177,000 patients die each year from no treatment decisions (Dignity in Dying report, 2006. p15)[31] Dr. Michael Wilkes, Chair of the British Medical Association’s Ethics Committee asked “If competent people can now make legally binding decisions to refuse life-saving treatment knowing that treatment will lead to their death, to then go a little further where people could make competent decisions to determine the time and the way they die, how big a step is that?”[32] . On page 16 of the same report a survey of healthcare professional in the UK shows a small majority of medical are supporters of assisted suicide.

Religious disapproval of suicide according to Steinbock has become less relevant as an arbiter of ethics and policy. In democratic societies that might be best described as secular with Christian heritage, the view of religious groups should not restrict the liberty of individuals in society, (Steinbock 2005, p.236). If Steinbock is correct then why did the Court Of Human rights allow submissions from the Roman Catholic Bishops’ Conference of England and Wales in the Pretty case? In an NOP survey in 2004 of religious respondents (n= 790) supporting and opposing medically assisted dying , 82% supported medically assisted dying. 81% of both catholic and protestant respondents agreed with it while Muslim respondents were split 42% for 49% against with 9% don’t know.[33] It’s clear from these results that Steinbeck is correct that the church has less influence on individuals in relation to assisted suicide.

It may be the case that revision of penal codes and laws will have the greatest impact over time. It may be possible to learn from others countries such as Switzerland and the Netherlands where euthanasia and assisted suicide a legal to some extent, but with differences in moral, social, and even religions it may be more beneficial to engage the public in a wider debate on the issue. The fear of double effect and the slippery slope will always be an issue for anti assisted suicide campaigners, but it’s essential that the UK Government use good Governance to monitor any changes to the suicide act that allow any form of assisted suicide.

It seems clear from recent surveys from the general British public, medical professionals, and religious groups that there is a move towards acceptance of assisted suicide under certain circumstances. This is a far cry from the Pretty case where Article 2 of the Convention for the Protection of Human Rights and Fundamental freedoms protected life indisputably. “Article 2 cannot, without a distortion of language, be interpreted as conferring the diametrically opposite right, namely the right to die; nor can it create a right to self-determination in the sense of conferring on an individual the entitlement to choose death rather than life”.

The question we need to ask ourselves is “should people be allowed to dictate their own life and death”? Should this question of life and death be a personal choice? Should the church, state and judiciary be involved in decisions of self determination?

[3] http://www.medterms.com/script/main/art.asp?articlekey=20909 Accessed 14/06/11
[4] Convection for the Protection of Human Rights and Fundamental Freedoms, Nov. 4,1950, art.2, 213 U.N.T.S. 222, 224
[5] Termination of Life on Request and Assisted Suicide (Review Procedures Act) 1st April 2001, Staatabald 2001, 194.
[6] All Party Parliamentary Group for assisted dying Home page. http://www.dyingwell.org.uk Accessed11/06/11
[7] The House of Lords Select Committee Report on The assisted Dying for the terminally ill Bill. 2005. www.parliament.uk accessed 11/6/11. http://www.publications.parliament.uk/pa/id200304/idbills/017/2004017.pdf accessed 11/06/11
[8] ibid at 6.
[9] Lord Joffe’s address to the House of Lords May 2006. http://www.perliament.the-stationery-office.co.uk/pa/ld199900/ldhansard/pdvn/lds06/t accessed 11/06/11
[10] See Pretty v The United Kingdom, European Court of Human Rights Judgment. Paragraph 28.
[11] Law shall protect everyone’s right to life. No one shall be deprived of his life intentionally save in the execution of a sentence of a court following his conviction for a crime for which this penalty is provided by law.
[12] No one shall be subjected to torture or to inhuman or degrading treatment or punishment.
[13] Everyone has the right to respect for his private life and family life, his home and correspondence.
[14] Everyone has the right to freedom of thought, conscience and religion; this right includes freedom to change his religion or belief, in worship, teaching, practice and observance,
[15] The enjoyment of rights and freedoms set forth in this Convention shall be secured without discrimination on any ground such as sex, race, color, language, religion, political or other opinion, national or social origin, association with a national minority, property, birth or other status.
[16] Judgments – The Queen on the Application of Mrs. Diane Pretty v Director of Public Prosecutions and Sectary of State for the Home Department. Session 2001 – 2002 UKHL 61. Paragraph. 10 Available at http://www.publications.parliament.uk/pa/ld200102/idjudgmt/jd011129/pretty-1.htm
[17] Pretty v United Kingdom Application no. 2346/02[2002] ECHR 427. Paragraph 31. http://bailii.org/eu/cases/ECHR/2002/427.html Accessed 10/06/2011
[18] ibid. Paragraph 40
[19] ibid. Paragraph 18.
[20] The Court was referring to McCann V United Kingdom In, which the SAS used force to kill and IRA active team in Gibraltar. The challenge was the SAS (UK) had used disproportionate force contravening Article 2. No. 19009/04 ECHR 2008 (13-05-2008) See case notes at http://hrlrc.org.au/files/ZLRJZJNUI/McCann%20v%20United%20Kingdom.pdf Accessed 17/06/11
[21] BBC News UK human Rights Act, How it Works.

http://news.bbc.co.uk/2hi/uk_news/946390.stm accessed 13/06/11
[22] Available at http://www.telegraph.co.uk/news/uknews/crime/7271008/Record-numbers-of-Britons-ended-their-lives-at-Dignitas-last-year.html Accessed 27/06/11
[23] Available at http://www.cps.gov.uk/publications/assisted_suicide.html Accessed 22/06/11
The Policy provides guidance to prosecutors on the public interest factors to take into account in reaching decisions in encouraging assisted suicide. (DPP. Keir Starmer, CPS Home Page: Publications: Prosecutions & Guidelines: Assisted Suicide)
[24] Available at http://news.bbc.co.uk/2/hi/health/1983457.stm accessed 24/06/11

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December 3, 2012
Canada Assisted Suicide
Most places in the world have some sort of law about Euthanasia or physician-assisted Suicide. In Canada, it is against the law for a physician to aid a person in ending their own life (Criminal Code of Canada states in section 241(b ). Assisted Suicide is defined as suicide facilitated by another person, especially a physician, who organizes the logistics of the suicide, as by proving the necessary quantities of a poison. There are many people that are for and against assisted suicide; that is why this issue remains a sensitive and complex issue for many. Currently in Canada the books on both passive euthanasia (withholding of life-preserving procedures) and active euthanasia (assisted suicide) both forms are illegal. Recently in July, 2012 a British Columbia Supreme Court overturned the criminal code for Assisted Suicide citing that it unfairly infringes on the Canadian Charter of Rights and Freedoms. The court has given a reprieve to the legislature for a challenge or change in the law before it goes into effect. I will discuss both sides of the issue of Assisted Suicide and the relevant cases that came before the Canadian Courts past and the case that eventually swayed the Supreme Court to reverse the laws of the land.
It used to be easy to define when one was dead, either when ones heart stop......

...been first been legalized for only the terminally and later laws are changed to allow it for other people or to be done non-voluntarily.
Opposition overcomes 48 point deficit to defeat assisted suicide - Ballot Question 2 in Massachusetts
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BOSTON, Nov. 7, 2012 /PRNewswire/ -- In a stunning upset, the voters of Massachusetts soundly defeated Ballot Question 2 on Election Day. Dealing a significant setback to the expansion of the assisted suicide movement throughout the United States by Compassion & Choices (the organization formerly known as the Hemlock Society), a diverse coalition of disability rights organizations, medical associations, nurses' groups, community leaders and faith-based organizations united in this effort.
"Tonight was a huge victory for those of us in the disability rights community that have worked for so long against assisted suicide," noted John Kelly , Director of Second Thoughts – People with Disabilities Opposing Question 2.
"This vote confirms that Massachusetts voters saw through the rhetoric and outright misinformation put out by those supporting assisted suicide. Opposition to assisted suicide cuts across all partisan and ideological groups because the more people learn about the issue, the more they have second thoughts. Assisted suicide doesn't expand choice, it limits choice – and that puts at risk anyone living with a disability, mental illness or serious illness."
A late September poll sponsored by the......

...Nuela, Jayson G.
BSBA-II
CAUSES OF EUTHANASIA
The causes of euthanasia are usually advanced illness and a person's desire to end the suffering. The effects vary. Those who assist suicides can face criminal charges. They also have to live with ending a life, especially the life of a loved one.
What is the difference between euthanasia and assisted suicide?
Euthanasia and assisted suicide can be distinguished by considering the act without which the death would not occur. If a third party or a person performs the last act that intentionally leads to patient’s death, then it is called euthanasia. For example, giving a patient a lethal injection or putting a plastic bag over her head to suffocate her would be considered euthanasia.
On the other hand, it is an assisted suicide when the patient himself performs an act that leads to death, but has been assisted by a doctor or some other person. Thus it would be assisted suicide if the patient dies after swallows the overdose of drug provided by his doctor for the purpose of causing death.
METHODS OF EUTHANASIA
When, however, an action or medication is withheld from a patient for the primary purpose of causing or hastening death, this is passive, or indirect, euthanasia. These measures may include the with-holding or withdrawal of ordinary measures such as food, water (hydration) and oxygen.
Examples of passive euthanasia are:
when food and water is withheld from sick or disabled newborn babies who......

...Nursing Leadership & Health Care Systems Management (University of Colorado, Denver), Higher Dip. Critical Care Nursing (Nbi).
Graduate Assistant, School of Nursing & Biomedical Sciences, Kabianga University College (A Constituent College of Moi University), . P 0 Box 2030 20200 Kericho, Kenya , Tel +254 722224577, Email: symomash@gmail.com
ETHICAL DILEMMAS FACING NURSES ON END-OF-LIFE ISSUES BASED ON CONFERENCE PROCEEDINGS HELD IN ELDORET, KENYA
ABSTRACT
Problem Statement: A conference to discuss on ethical dilemmas is thought to be a good way of airing out issues. It is unfortunate that at times a patient in our care may die no matter what we do. Profound ethical questions on end of life issues confront the medical personnel as they watch and wait helplessly. This paper touches on ethics, law, social and public policy as they affect nursing practice.
Setting: This is a conference proceedings report augmented with a case study of Nelly from a local setting and compares it with two others from elsewhere which were also presented during the conference. Conference was organized by Federation of African Medical Students Associations (FAMSA), Eldoret 2011. The author was a presenter and discussant. This paper is a compilation of the ideas, inspirations and reflections of the significant sessions and also fulfills some of the recommendations resulting from the distinguished......

...time. Mr. Ladhani is being assisted by qualified and experienced personnel of technical, management, finance and marketing and by his four sons named as Mr. Rakesh Ladhani, Mr. Naresh Ladhani and Mr. Rajesh Ladhani, Mr. Roshan Ladhani, M.B.A. from U.K., who are technically and professionally qualified and are well experienced who are the key persons of various projects.
Products
* Coca Cola
* ThumbsUp
* Limca
* Fanta
* Sprite
* Diet Coke
* Kinley Soda
* Kinley water
* Maaza
* Minute maid pulpy orange
* Minute maid Nimbu Fresh
Our Vision
Our vision serves as the framework for our Roadmap and guides every aspect of our business by describing what we need to accomplish in order to continue achieving sustainable, quality growth.
People: Be a great place to work where people are inspired to be the best they can be.
Portfolio: Bring to the world a portfolio of quality beverage brands that anticipate and satisfy people's desires and needs.
Partners: Nurture a winning network of customers and suppliers, together we create mutual, enduring value.
Profit: Maximize long-term return while being mindful of our overall responsibilities.
Productivity: Be a highly effective, lean and fast-moving organization.
Our Values
We always try to do the right thing.
We are data-based and intellectually honest in advocating proposals, including, recognizing risks.
We focus our resources to......

...takes place during the nineteenth century and focuses on the point of view of Edna Pontellier, the protagonist and wife elite to an affluent Creole. The story begins at the Grand Isle resort, which is a popular vacationing stop for the wealthy from New Orleans. While at Grand Isle, Edna comes to the realization that she is longing for self-actualization and empowerment. The novel then moves to the city of New Orleans where Edna is determined to break society’s mold of women of what is expected of the time period. While in New Orleans, she pursues her desire to paint in order to achieve a sense of personal freedom. Ultimately, the story leads us back to Grand Isle where Edna has reached her lowest point in life and decides to commit suicide to end all of her pain. The novel is written with a feminist perspective in which psychoanalytical ideations plays a significant role. When one sees or hears the word psychology, the first thing that comes to mind is Sigmund Freud. His research on psychoanalysis focuses on the “repression and unconscious forces and includes the concepts of infantile sexuality, resistance, transference, and division of the psyche into the id, ego, and superego” (Farlex, 2009). Edna Pontellier is a character who exhibits the psychoanalytical concepts of Freudianism.
Throughout the novel, Edna’s id plays a drastic role in her infantile sexuality. As the novel progresses she seems to demonstrate affection for several of the characters. ......

...Teen Suicide Research Paper
People need to be informed on why teens commit suicide and what signs to look for. Teens are slowly slipping away because of this deadly subject and people need to start noticing. Sometimes people can get caught up in their own personal lives and not even notice when a loved one is considering suicide. In the seven articles read, there were a variety of things that people seem to overlook often. Why teens are committing suicide and what people can do to help victims who are considering, are two main points that are important for people to know. In a Kids Health article about teen suicide, it talks about teen suicide and different things people need to know about it.
According to the Centers for Disease Control and Prevention, suicide is the third leading cause of death for 15 to 24 year-olds. Most of the time, people don’t realize that they could have helped a victim because they didn’t know any of the warning signs. The article goes on to talk about the risks of suicide, that 60% of all suicide in America are used with a gun. This is why no one should ever have a gun unlocked or kept in a place where it is easily out of reach. In 1996, more teenagers and young adults died of suicide than from cancer, heart disease, AIDS, birth defects, stroke, pneumonia and influenza, and chronic lung disease combined .In 1996, suicide was the second-leading cause of death among college students, the third-leading cause of death among those aged 15 to 24 years,...

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Knowledge Area Module VI
Contemporary Issues and the Ethical Delivery of Health Services
Student: Harold Taitt, harold.taitt@waldenu.edu
Student ID # A00293212
Program: Ph.D. Health Services
Specialization: Health Management and Policy
Faculty Mentor: Dr. Robert Hoye, robert.hoye@waldenu.edu
Faculty Assessor: Dr. Jim Goes, jim.goes@waldenu.edu
Walden University
May 10, 2013
Abstract
Breadth Component
In this age of rapidly evolving technological advances, many of the legal and ethical issues that are challenging the delivery of health care and the health care profession are new. As we confront the legal, moral, and ethical aspects of health care, we are seldom faced with decisions that require or are resolved by simple right or wrong answers (Edge & Kreiger, 1998). In the Breadth component of KAM VI, I focus on several ethical theories and how those theories influence the way ethical issues and concerns are addressed and managed in the allocation and delivery of health care services. I critically assess and evaluate those theories, concepts, and derivative principles as they impact important decisions and the implications of those decisions within the context of social change and with special emphasis on health care management and policy. In addition, I discuss the key assumptions on which the selected theories are constructed, compare and contrast the writers’ interpretations across theories, and conclude by providing a critical commentary on the merits......

...people is a broad one and is defined differently according to people and organizations, but generally “indigenous people are those that have historically belonged to a particular region or country, before its colonization or transformation into a nation state, and may have different often unique cultural, linguistic, traditional, and other characteristics to those of the dominant culture of that region or state” (Barnard 1992).
Ancestral land conflict in Botswana
Since the mid-1990s, the San were forced out of their land by the central government of Botswana which used a relocation policy they came up with, which aimed at moving the San out of ǃXam Khomani Heartland, their ancestral land on and near the Central Kalahari Game Reserve (CKGR), into a foreign land called New Xade ( Taylor 2007). The government however came up with reasons on why they were moving the San from their ancestral land which were, some of the San people wish to be agriculturists and having livestock and no more hunting and gathering ( Taylor 2007). Also that the San people way of living was not contradictory to those of the Game Reserve which aimed at sustainability with preserving wildlife resources. This was the main reason for government to relocate the CKGR residents. However the government denied any forced removal ( Taylor 2007). The relocation policy was to serve the government and all those that seemed to gain from this, it is evident that the removal of the San people was for tourist......

...Science, St. Xavier’s College Kolkata, India Email: saradindu.naskar@gmail.com
Abstract ─ My military robot has got two barrel
turret through which bullet can be fired; radio camera in synchronization with the turret can rotate up and down, left and right up to a safe firing limit. Turret and camera mechanism has been installed on my robot vehicle, which has all the function like tank, turning to any angle on its axis, moving forward and reverse turning left and right, running instantly into reverse direction. This robot is radio operated; self powered, has image processing facility and has all the controls like a normal car. A pair of laser gun has been installed on it, so that it can fire on enemy remotely when required; this is not possible until a wireless camera is installed. Wireless camera will send real time video and audio signals which could be seen on a remote monitor and action can be taken accordingly. It can silently enter into enemy area and send us all the information through its tiny Camera eyes. It is designed for, fighting as well as suicide attack. Keywords─ISO, robot, DARPA, DSTA, RF, cockroach intelligence.
or mobile for use in industrial automation applications. “ All these definition do give us a rough idea about what comprises a robot, which needs to sense the outside world and act accordingly. There are motors, pulleys, gears, gearbox, levers, chains, and many more mechanical systems, enabling locomotion. There are sound, light, magnetic......

...hairy, human head; the latter - placed to the left - suggests moving by presenting a foot walking.
However, the term "Tao" is differently translated depending on the context of the doctrine in which it is understood. Thus, for Confucius and for his philosophical school, "Tao" refers to the art of ruling the state of the ancient emperors like King Wen and the Duke of Chou, famous characters in the history of China. For the Taoists, the same term alludes, in the late speculations, to an originary order of the universe, to the Beginning , the Origin of all the things or other similar concepts.
In the I -Ching, or "Book of Changes" as it is known in the West, Tao is said to represent "a yin and a yang". Or more precisely, a moving phenomena including alternation of contraries, like day and night.
The Yin Yang symbol:
The t'ai chi, more commonly referred to as the yin-yang symbol. Since nothing in nature is purely black or purely white, the symbol includes a small black spot in the light swirl, and a corresponding white spot in the black swirl.
In Taoism, Yin and Yang represents the balance of opposites in the universe. When they are equally present, all is calm. One cannot exist without the other, and they are considered to be complimentary aspects of the Tao that create natural order in the world. Taoist believe that nature is a continual balance between yin and yang, and that any attempt to go towards one extreme or the other will be ineffective, self-defeating......

...war in addition to foreign interventions in the form of the 1979 Soviet invasion and the 2001 U.S. invasion. The strategic interests of the great powers of the day in Afghanistan pitched against the potential threat of terrorism, religious extremism, smuggling and drug trafficking substantiates the assertion that Afghan security situation has the potential to generate effects far beyond its borders.
Afghanistan had experienced several coups since 1973, when the Afghan monarchy was overthrown by Daud Khan, who was sympathetic to Soviet overtures.
Subsequent coups reflected struggles within Afghanistan among factions with different ideas about how Afghanistan should be governed and whether it should be communist, and with degrees warmth toward the Soviet Union. The Soviets intervened following the overthrow of a pro-communist leader. In late December 1979, after several months of evident military preparation, they invaded Afganistan.
At that time, the Soviet Union and the United States were engaged in the Cold War, a global competition for the fealty of other nations. The United States was, thus, deeply interested in whether the Soviet Union would succeed in establishing a communist government loyal to Moscow in Afghanistan. In order to forestall that possibility, the United States began funding insurgent forces to oppose the Soviets.
The U.S.-funded Afghan insurgents were called mujahideen, an Arabic word that means "strugglers" or "strivers." The word has its orgins in......

...Antony restrained him, and started to move towards predominance. There was one other player, however. Caesar's will had (allegedly) listed C. Octavian as heir to his personal fortune and social position. Octavian's grandfather had married a sister of Caesar; Octavian was thus Caesar's grand nephew. At the age of eighteen, he had (somewhat unusually) just passed from equestrian to senatorial rank. He was currently out of Italy, doing military training, and returned to Rome as soon as he heard of Caesar's death, changing his name to C. Julius Caesar Octavianus. Passing through Italy, he had begun to collect supporters among veterans from Caesar's legions. He immediately found that Mark Antony had depleted Caesar's personal as well as state funds. Octavian still needed an army. He prevailed upon the Senate to provide him with the proconsular command in Cisalpine Gaul; however Decimus Brutus—related to the co-conspirator—was already on the ground there. It was around this time that the orator-politician returned to Rome and delivered his series of addresses entitled the Philippics, in which he repeatedly condemned Mark Antony as an aspiring despot. At this time those senators who had supported the assassination allied with Octavian as a brake on growing tyranny, granting him the propraetorship in Cisalpine Gaul, along with two legions. Around this time, D. Brutus defeated the besieging Mark Antony at Mutina. In this, D. Brutus was assisted by Octavian, who had linked up with......

...globalization has been identified with the policy reforms of 1991 in India. The Important Reform Measures (Step Towards liberalization privatization and Globalization) Indian economy was in deep crisis in July 1991, when foreign currency reserves had plummeted to almost $1 billion; Inflation had roared to an annual rate of 17 percent; fiscal deficit was very high and had become unsustainable; foreign investors and NRIs had lost confidence in Indian Economy. Capital was flying out of the country and we were close to defaulting on loans. Along with these bottlenecks at home, many unforeseeable changes swept the economies of nations in Western and Eastern Europe, South East Asia, Latin America and elsewhere, around the same time. These were the economic compulsions at home and abroad that called for a complete overhauling of our economic policies and programs. Major measures initiated as a part of the liberalization and globalization strategy in the early nineties included the following: Devaluation: The first step towards globalization was taken with the announcement of the devaluation of Indian currency by 18-19 percent against major currencies in the international foreign exchange market. In fact, this measure was taken in order to resolve the BOP crisis
Disinvestment-In order to make the process of globalization smooth, privatization and liberalization policies are moving along as well. Under the privatization scheme, most of the public sector undertakings have been/ are......